Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

As most readers will know, scribes have gone from a neat idea to a fixture in many clinical settings. Though the long-term effect of their participation has yet to be determined, so far it seems that scribes have been proven to be quite useful. Not only are they saving time, they’re helping physicians connect with patients again, rather than their computer screen.

That being said, when you hire a scribe you don’t always know what you’re getting. After all, there’s no such thing as a scribe certification accepted by the healthcare industry as a whole. There are schools which offer aspiring scribes a thorough education in the essentials of medical terminology and practice, but they don’t need to adhere to a single national standard.

This lack of standardization could turn out to be a problem, according to Dr. Jeffrey Gold. In an article for The Doctor Weighs In, Dr. Gold concedes that scribes seem to be offering real benefits, noting that researchers have found that scribes can enhance physician efficiency, boost physician satisfaction and even increase billing. And he notes that scribes may improve patient satisfaction, as they make it easier for physicians to connect with patients during visits.

But despite the benefits they offer, Dr. Gold says he’s concerned about the lack of regulation concerning how scribes participate in healthcare. For example, he notes that researchers haven’t yet assessed scribes’ ability to interface safely with the EMR.

His concerns seems to be shared by the Joint Commission, which requires that providers signed all scribe-generated orders prior to implementation, that healthcare organizations document the ability of scribes to perform their assigned tasks. These concerns arise because scribes aren’t held to a common standard, Dr. Gold contends.

“Scribes have a wide variety of backgrounds, including premed students and certified medical assistants,” he notes. “…Unfortunately, few rules or standards currently exist that designate appropriate scribe activities.”

Scribe training varies a great deal as well, he notes. To make his point, Dr. Gold cites a study by medical malpractice insurer The Doctors Company and Oregon Health and Science University which looked at scribe capabilities and backgrounds. He notes that the survey, which had 335 respondents, found that 44% of scribes had no prior experience, and that only 22% of scribes have had any form of certification.

Under these circumstances, using scribes might come with some unexpected risks, he suggests. “The combination of rapid growth in scribe use, lack of standardized training, variability in scribe experience, and variability in both EHR exposure and EHR workflows raises the concern that scribes may introduce potential negative unintended consequences to either workflow or documentation,” he writes.

It is worth noting that another of Dr. Gold’s fears is that scribes will be asked to take on more complex EMR work which, if handled badly, could also lead to problems. He’s concerned that scribes may simply accumulate such duties due to “functional creep.”

For myself, while I understand Dr. Gold’s concerns, I don’t feel the situation is as dire as he suggests. Yes, it would probably be appropriate and beneficial to standardize scribe training, as it never hurts to boost the professionalism of any party participating in the care process. At the same time, though, with many scribes being trained largely by their employers, there will be a lot of variation in outcomes anyway.

But maybe I’m wrong. What do you think? Is it important to give scribes or standardized training and ask them to meet national certification standards? Or are they working effectively as is?

4 responses to "Do We Need Stricter Scribe Standards?"

Have we not learned a single thing about national certification standards and how they are totally meaningless, costly, burdensome?
We do NOT need yet another governing body, certification standard for scribes.
Its typing in a computer.
Let try to settle down a bit and think about how to STOP unnecessary certifications, like EHR cert, MOC, HIPAA nightmares (like BAA, etc), etc. etc.
Everytime someone says we need a new national certification standard or just have the doctors “document” that, someone is gets fired.

Scribes are an aberration of bad healthcare IT (EMR) systems and implementations. Rather than gradually reducing personnel with the adventure of technology as we have done, for example, in the digitization of medical imaging, EMRs have added yet another layer of cost, in medical scribes, to our already ridiculously expensive system. Responsible physicians should do everything they can to avoid the introduction and use of scribes.

@Brio: The “functional creep” Dr. Gold addressed in his article was the tendency for scribes to pick up additional – and possibly inappropriate – duties that weren’t originally part of their job description.

Other posters: I actually agree scribe certification probably isn’t a good idea, or at least isn’t needed, and that the need for scribe reflects ongoing poor EMR usability. However, because they are still in wide use, probably still makes sense to look at these issues.